Interim
Joint Committee on Health and Welfare

Subcommittee
on Families and Children

Minutes
of the<MeetNo1>3rd Meeting

of
the 2009 Interim

<MeetMDY1>October 21, 2009

The<MeetNo2>3rd meeting of the Subcommittee on
Families and Children of the Interim Joint Committee on Health and Welfare was
held on<Day>Wednesday,<MeetMDY2>October 21, 2009, at<MeetTime>10:00 AM, in<Room>Room 129
of the Capitol Annex. Representative Tom Burch, Chair,
called the meeting to order, and the secretary called the roll.

Guests: Eric Clark for the Kentucky Association of
Health Care Facilities; and David Graves for Brooklawn.

LRC Staff: Ben Payne, Amanda Dunn, and Cindy Smith.

The first item on the agenda was an update on the First
Steps Program by Ruth Ann Shepherd, MD, FAAP, Director, Maternal & Child
Health, Acting Director, Division of Women's Health, Department for Public
Health, Cabinet for Health and Family Services; and Paula Goff, Part C
Coordinator, First Steps Program, Department for Public Health, Cabinet for
Health and Family Services. Ms. Goff said that the First Steps Program is a
statewide early intervention system that provides services to families with
children from birth to age three who have developmental disabilities.

Ms. Goff discussed with the committee that First Steps
focuses on providing family centered services by utilizing a Consultative
Model. This is done by a therapist providing consultation and instruction to
the child’s caregivers, who in turn actually provide the interventions
throughout daily routines. The specific services provided through the
Consultative Model are based upon the Individual Family Service Plan, known as
an IFSP, which is developed for each child and family participating in the
First Steps Program. The subcommittee learned that there is a national four
tier ranking system for these types of programs. Kentucky is currently at
level three and anticipates rising to level two by June 2010. Kentucky’s
federal funding is not in danger as long as the state program does not drop to
level four.

The subcommittee learned that 12,900 children are served
each year by First Steps and that there are currently 6,462 Kentucky children
with and active ISFP. First Steps is funded through a combination of General
Fund dollars, Tobacco Settlement Funds, Family Share, Insurance, Medicaid,
Federal Part C, and Federal ARRA funds.

Representative Burch asked about Kentucky’s rank and how it
is determined. Ms. Goff said there are annual performance reports completed
every February and after the next performance report, Kentucky should be able
to move to a level two by June, 2010.

Representative Housman asked if Kentucky’s determination as
a level three puts federal funding in jeopardy. Ms. Goff said the funding
would only be in jeopardy if Kentucky dropped to a level four.

Representative Housman asked if there is a timeline for
level movement. Ms. Goff said yes, and there are visits with OCEF every three
months.

The final item on the agenda was a presentation on Psychiatric
Residential Treatment Facilities (PRTF’s) by Kerry Harvey, General Counsel and
Acting Inspector General, Office of Inspector General, Cabinet for Health and
Family Services; and Stephanie Brammer-Barnes, Policy Analyst, Office of
Inspector General, Cabinet for Health and Family Services. The subcommittee
heard testimony that described what PRTF’s are and where they are located
throughout the state. PRTF’s have existed in Kentucky since 1991 and are for
patients age 6 to age 21 who have an emotional or severe emotional disability.
Currently there are 21 PRTF’s in the Commonwealth. As of October 2009, there
are approximately 189 PRTF patients. The state has a CON capacity for nearly
100 more patients.

Staffing requirements were discussed showing that the
professional requirements range from high school diploma minimums for the
majority of staff, to college degrees for those staff that run the facilities.
The subcommittee learned that during 2008, 228 children were provided care in
out-of-state facilities due to the fact that Kentucky PRTF’s cannot offer them
the treatment services they need. Additionally the subcommittee learned that
the average per day payment for out-of-state care is $340 and the average per
day payment for in-state care is $400.

Representative Burch asked if there is a psychiatrist on site
or on call. Ms. Brammer-Barnes said a psychiatrist is on call, but is also
required to be there at least one day each week.

Representative Burch said after talking with providers, he
learned that 18 girls could be worked into two different PRTF’s in Jefferson
County from out-of-state facilities if the regulation was changed just a bit,
and he requested to meet with Mr. Harvey and Ms. Brammer-Barnes after the
meeting to discuss that.

Representative Burch asked if the $339.10 per day per
resident includes parent transport. Mr. Harvey said the per diem does not
included parent transport.

Representative Burch asked what the outcomes are of
out-of-state children. Mr. Harvey said the outcomes are all over the board;
some get better, while others do not. Mr. Harvey said that he is sure that
outcomes data exists within the Cabinet, but that data is not in the Office of
the Inspector General.

Representative Jenkins asked how many kids are out-of-state
daily. Mr. Harvey said there are currently between 40 and 60 children from
Kentucky in out-of-state facilities.

Representative Jenkins asked how much money is paid
out-of-state for care of children from Kentucky. Mr. Harvey said he did not
have any idea, and that information is not in the purview of the Office of the
Inspector General.

Representative Jenkins asked if the kids that have been
placed out of state are in PRTF’s or psychiatric hospitals. Mr. Harvey said
some are in facilities similar to PRTF’s, and some are in facilities more like
hospitals.

Representative Jenkins said the committee is going to need
the answers to these questions in the coming week. Mr. Harvey said that the
results from the survey on out –of-state kids could be provided to the
subcommittee members.

Representative Burch said there are 100 beds that are still
available and asked why they are not being utilized. Mr. Harvey said that the
CON has been granted, and the beds are being built. Representative Burch said
there are many beds available in rural areas and he asked why those beds are
not online. Mr. Harvey said no provider has stepped forward to provide those
beds.

Representative Burch asked if the Cabinet is actively
looking for providers to fill the beds. Mr. Harvey said the providers must be
committed to the project and the staffing can be taken care of.

Representative Housman asked if Kentucky has the capacity
and the training to treat the children that are in out-of-state facilities.
Mr. Harvey said the specialized treatment does not exist in Kentucky to treat
that group of out-of-state children.

Representative Burch asked if all out-of-state kids are
monitored. Mr. Harvey said efforts are in place, but it is very difficult to
monitor children in other states.